School Registration Form 2018-2019

Note: fields marked as * are required. When all sections have a green checkmark beside it, you can save the form.fV

Personal Information

Last Name*

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First Name*

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Grade Enrolling In:*

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Birth Date:*

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New Student

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Ethnicity

Gender

Student Lives With:

Sibling Information

Sibling 1 Name and Age

Sibling 2 Name and Age

Sibling 3 Name and Age

Sibling 4 Name and Age

Student's Church

Name

Affiliation

Member?

Baptized?

We Require that all Non-Lutheran parents attend a "What We Believe, Teach and Confess" class conducted by The Pastor.
In this class you will be informed of doctrine that is taught at Prince of Peace Lutheran School.
Please check the website for dates or contact the school as to when this class will be held.

I have attended this class*

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Why Do You Desire Your Child To Attend This School?

Following is a list of the 9 most common reasons parents enroll their children in a Christian School.
Please rank the top 3 in order from 1 (being the most important) to 3 (being the lease important) that they apply to you personally.

High Academic

Spiritual Development

Good Work Habits

Extended School Care

Social Development

Extracurricular Activities

Self-Esteem Development

Safe Enviroment

Technology

Moral Development

Other

Other Information

How Did You Hear About Us?

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Name of School Previously Attended

Previous School Address

Previous School Phone Number

Emergency Contact Information

I authorize Prince of Peace Lutheran Church and Schools to release my children to the following persons:

(1) Full Name*

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Relation to Student*

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Phone #*

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(2) Full Name

Relation to Student

Phone #

(3) Full Name

Relation to Student

Phone #

Out of State Contact Information

Full Name

Relation to Student

Phone #

Address

Parent Authorization

I understand that if my child has an emergency they will be taken to the closest emergency room to Prince of Peace.
I will pay physician's fees not covered by insurance.
If necessary, I authorize emergency treatment by any certified paramedic, licensed physican and/ or hospital.
Emergency contacts will be notified by Prince of Peace.

By entering my name below I am providing a digital signature which denotes authorization.

List Students Enrolling in 2018-2019 Prince of Peace Lutheran Church and Schools

Name:

Grade:

Name:

Grade:

Name:

Grade:

Name:

Grade:

Fee Schedule

Early Bird Registration: Feb 22nd - Apr 28th, 2018

Registration Fee (non-refundable)

Tuition

K - 2: $525

1 Child: $5100

3 - 8: $450

2 Children: $9700

3 Children: $14,275

4 Children: $18,850

Technology Fee

3rd - 8th Grade: $350

3rd Year in the iPad Program: $150

Registration 2018-2019

Registration Fee

Tuition

K - 2: $575

1 Child: $5400

3 - 8: $500

2 Children: $10,000

3 Children: $14,575

4 Children: $19,150

Technology Fee

3rd - 8th Grade: $350

3rd Year in the iPad Program: $150

Payment Plans

Please select one:

Annual Payment Plan - Full payment of yearly tuition. Receive a 5% discount if paid in full by July 1st with cash or check
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Monthly Payment Plan - Payment of tuition monthly over a 10 or 12 month period.
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Tuition and Fee Policy:

All fees are non-refundable on a prorated basis after a written statement of withdrawal is received. Accounts which become more than 30 days delingquent will result in the dismissal of the student. If you anticipate a problem makeing payments, please contact the school office in advance.

Volunteer Hours Policy:

Each family has the choice of giving 40 service hours of their time or paying $10 for each hour not served.

Signature of Person Responsible for Payments and Fees:

By typing in your name below, you are agreeing to paying tuition and fees according to the financial agreement.

Signature:*

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Parent/Guardian Name:*

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Phone:*

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Email:*

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Student Name(s):

I hereby give Prince of Peace Lutheran Church and School the absolute right to photograph, interview or film my child(ren) listed above and copyright and / or publish the pertinent materials in whole or in part for printed materials, advertising, public information or any other lawful purpose.

I hereby waive any right that I may have to inspect and/ or approve the finished product or the copy that may be used in connection therewith, or the use to which it may be applied.

I hereby release, discharge and agree to save the above mentioned from any liability by virtue of any blurring, distortion, alteration, optical illusion of use in composite form whether intentional or otherwise, that may occur or be produced in the making of said picture, or in any processing tending towards the completion of the finished project.

Do NOT publish photos of students listed above.

Signature:*

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Student Information

Student First Name:

Last Name:

Birthday:

Grade:

Parent Information

Parent First Name:

Parent Last Name:

Phone:

Email:

Physician Information

Physician Name:

Physician's Phone:

Medication Information

We, the undersigned, request that a member of the school staff administer to our child the medication prescribed according to the instructions given to us, by our physician.

We will file any new medication instructions immediately if the medication or dosage is changed.

Any medication that must be given on a daily basis for a long period of time will require a doctor’s letter with a signature.

Physical condition for which drug is given: (If allergic in nature, please specify what type of reaction and indicate in detail those visible symptoms which would give rise to the necessity of administering the medication.)

Medication

Dosage and method of Administration

Possible reaction that should be reported to the physician

Therefore the above medication cannot be scheduled for other than during school hours and such medication maybe administered by medically untrained school personnel whenever necessary.

Medication to be continued as above until

Signature: (Your signature is your authorization)

Parent Teacher Alumni League

Parents are essential in the process of Christian education. WIthout your dedicated effort, a quality job of education cannot be accomplished.
Therefore, Prince of Peace needs all parents (family members welcome) to be involved in the Parent Participation Program.
Each family must donate 40 hours of service per school year at the school or church through one or more of the follosing ways:

Family Name*

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The category(ies) of involvement I/we have chosen is:

At least one of the following options must be selected.

Family Service Day

Hours (9am - Noon). Each year we have approximately 7 workdays to accomplish painting jobs, yard work, cleaning, and repairs. Maintenance personnel or the head Trustee will coordinate these projects.

School Volunteer Day(select one)

Lunch Supervisor

K - 2nd (11:45 am - 12:45 pm) 3rd - 8th (12:00 pm - 12:45 pm)

Days You Will Work:

Room Parent

Other

Fundraisers

Capital Funds

Over the past few years, many large items have been purchased to enhance the quality of the educationl program at POP.
Items such as computers and bathroom facilities are examples of these purchases.
If you are unable to help in any of the volunteer groupings above, you are required to participate by giving $400.00.
The check should be made out to POP and given to the school office (or you may contribute online at our payment page).
We continually praise and thank God for you, our wonderful parents, and for your support in helping to meet the needs of our school. Together we can provide our children with both academic and spiritual growth.

We the undersigned have read and understand the "Parents Participation Program" and our requirements to the PTAL of Prince of Peace Lutheran Church and Schools. Our name entered below is our agreement.